From Dr Gary Wu, General Practitioner, Auckland

前列腺保健

簡介

前列腺（Prostate），又稱攝護腺，是雄性哺乳動物生殖系統中的一個器官，屬外分腺。是男人的生殖和泌尿系統的一部分。

男子發育後，在血睾丸酮作用下形成底部橫徑 4 釐米，前後徑 2 釐米；縱徑 3 釐米，外形如同倒放的栗子樣圓錐體。它位於膀胱頸的下方，包繞著膀胱口與尿道結合部位，即：前列腺中間形成的管道構成尿道的上口部分。實際大小因人而異，它的大小範圍可以從一個核桃至一個小蘋果。

前列腺是由不同類型的細胞：
– 腺細胞產生精液的液體部分
– 肌肉細胞，控制尿流射精
– 纖維細胞提供支持的腺體結構

前列腺的主要功能是分泌和儲存前列腺液，它分泌的前列腺液，含有抗菌因子保護尿道，每天以 0.5 – 2 ml 的量，經前列腺腺管，排到後尿道，隨尿液排出體外。前列腺腺管內存有一定量前列腺液。前列腺液可與精子混合成精液。

常見的前列腺疾病

前列腺炎 （Prostatitis）

前列腺炎是前列腺組織的炎症，它往往是由尿路感染引起的炎症。它通常會影響年輕男子，25 – 50 歲的年齡層。

前列腺炎通常會導致一些前列腺內的管道堵塞或刺激，其原因可能是感染。感染的原因可能是病毒或細菌（例如，性傳播疾病 Chlamydia）或尿液感染。

前列腺炎的症狀可能包括：
– 疼痛，燒灼感或尿頻
– 尿流薄弱或不完整的排空
– 發熱，寒戰，腰痛。

治療選項：
– 抗生素
– 良好的排尿習慣

前列腺增生 （Benign Prostate Hyperplasia）

良性前列腺增生症（BPH），俗稱前列腺肥大症，乃前列腺中葉增生為實質改變而引起的一組徵候群，是老年男性的常見病。它通常在中年開始。前列腺增生症不會導致癌症。

良性前列腺增生症的症狀可能包括：
– 尿流細小
– 解尿不乾淨
– 排尿後段滴瀝
– 尿柱斷續
– 需用力方能解尿
– 在夜間醒來排尿多次
– 頻尿（排尿後不到兩小時又想尿）
– 尿急（尿意強烈，甚至憋不住）

治療方案：
– 症狀輕微、不影響生活者，不需積極治療，只要注意水分攝取、避免憋尿即可。

– 若造成生活上的困擾，如頻尿、夜尿多次影響睡眠者，可用口服藥治療。
藥物治療中第一線以甲型阻斷劑（α-blocker）為主，如 terazosin /doxazosin 等。前列腺體積較大者可服用 5α 還原酶製劑如 finasteride / dutasteride 等，使前列腺體積縮小。

– 病情嚴重者可能需手術治療。（差不多四分之一的 BPH 的患者需要手術治療。）
手術治療中最具代表性的方法是經尿道前列腺切除術。此法從 1960 年代後期就成為前列腺最主要的手術方法。另外也可以從腹部或會陰部切口開刀切除前列腺。其他選擇有用雷射或微波破壞前列線組織，以改善尿流。

前列腺癌 （Prostate Cancer）

前列腺癌是出自前列腺的惡性腫瘤。大多數前列腺癌生長緩慢，但是，也有侵略性前列腺癌病例。若其中有細胞的基因突變導致增殖失控，就成為癌症。惡性細胞除了體積擴大或侵犯鄰近器官，也可能轉移到身體其他部位，尤其是骨頭和淋巴結。前列腺癌可能造成疼痛、排尿困難、勃起功能不全等症狀。

前列腺癌大多是在例行的健康檢查或抽血篩檢發現的。有關“前列腺特異抗原”（Prostate Speficic Antigen 即 PSA）的準確性和效果目前仍有一些疑慮，不過它仍是現今最廣泛廣用的前列腺癌篩選工具。發現疑似前列腺癌的個案時，應做切片檢查（取一小片前列腺組織，處理後用顯微鏡檢查）才能確立診斷。若是確定癌症，其他進一步檢查如 X光、電腦斷層掃瞄和骨骼掃瞄等，有助於瞭解前列腺癌是有否有外擴散。

前列腺癌的症狀可能包括：
– 排尿時疼痛／燃燒
– 尿中有血
– 后腰／臀／肋骨疼痛

治療選項：
– 觀察等待
– 手術
– 放射治療
– 激素治療
– 結合療法

前列腺保健 ＆ 前列腺癌日常預防

1. 健康飲食 （Pomegranate – 石榴，Tomato – 番茄，Isoflavones – 大豆異黃酮，Green Tea – 綠茶，Grapeseed oil – 葡萄子油，Folic Acid – 葉酸）
2. 多運動
3. 健康的生活方式 – 克服不良生活習慣，應盡量戒菸
4. 保持清潔／包皮手術
5. 健康的性活動 （年齡較早的性行為，使前列腺癌的風險增加；多重性伴侶也會使前列腺癌的高度病變的風險增加。）

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參考文獻 Reference for Prostate Self Care Tips – 前列腺癌日常預防

A) Healthy Eating – 健康飲食

Pomegranate – 石榴
The efficacy of pomegranate in clinical trials have further supported its use in the treatment of several diseases, in particular in the management of prostate cancer. Herein, we critically review the scientific knowledge about the current role and future prospects for the use of pomegranate extracts in the therapy of erectile dysfunction, benign prostatic hyperplasia, and prostate cancer.
*Reference:Pomegranate Extracts in the Management of Men’s Urologic Health
Authors: Kroeger N. Belldegrun AS. Pantuck AJ, 2013.

Tomato – 番茄
It’s suggested that tomato may play a modest role in the prevention of prostate cancer. Further research would be needed to determine the type and quantity of tomato products regarding their potential in preventing prostate cancer.
*Reference: Lycopene/Tomato consumption and the risk of prostate cancer
Authors: Chen J. Song Y. Zhang L, 2013.

Isoflavones – 大豆異黃酮
In vitro data are much more convincing in regard to the activity of a number of isoflavones, and have led to the development of genistein and phenoxodiol in the clinic as potential treatments for cancer.
*Reference: Clinical pharmacology of isoflavones and its relevance for potential prevention of prostate cancer
Authors: de Souza PL. Russell PJ. Kearsley JH. Howes LG,2010

Green Tea – 綠茶
Green tea and its major constituent epigallocatechin gallate (EGCG) have been extensively studied as a potential treatment for a variety of diseases including cancer. In this review, we highlight the evidences of green tea polyphenols from preclinical and clinical studies in the chemoprevention/chemotherapy of Prostate cancer.
*Reference: Green tea polyphenols in chemoprevention of prostate cancer
Authors: Khan N. Adhami VM. Mukhtar H,2009.

Grapeseed oil – 葡萄子油
Any use of grapeseed supplements was associated with a 41% reduced risk of total prostate cancer. There were no associations for use of chondroitin, coenzyme Q10, fish oil, garlic, ginkgo biloba, ginseng, glucosamine, or saw palmetto.
*Reference: Specialty supplements and prostate cancer risk
Authors: Brasky TM. Kristal AR. Navarro SL. Lampe JW. Peters U. Patterson RE. White E, 2011.

Folic Acid – 葉酸
Results of this study suggest that higher folate status may be protective against elevated PSA levels among men without diagnosed prostate cancer. Additional epidemiologic studies are necessary to confirm our findings and to investigate potential mechanisms.
*Reference:Serum folate and prostate-specific antigen in the United States.
Authors: Han YY. Song JY. Talbott EO, 2013

B) Physical Activity – 多運動
There is a growing body of epidemiological research suggesting that physical activity is protective against the development of prostate cancer. This paper reviewed 22 studies published in the past 12 years updating an earlier review finding that although some studies show no benefit and a very few show increased risk for prostate cancer, the majority of studies document a significant, albeit small, protective effect of physical activity.
*Reference: Potential for prostate cancer prevention through physical activity.
Athour: Young-McCaughan S, 2012

C) Healthy Lifestyle – 克服不良生活習慣，應盡量戒煙
About 30% of all human cancers are caused by tobacco smoking and inhaled pollutants. Tobacco exposure enhance the inflammation in prostate carcinoma patients in stratified group as it have been represented as a risk factors in various cancers, but this study provide further its role that seems to influence inflammation especially in prostate carcinoma.
*Reference:Tobacco exposure may enhance inflammation in prostate carcinoma patients
Authors: Dwivedi S. Goel A. Mandhani A. Khattri S. Pant KK, 2012

D) General Hygiene / Circumcision – 保持清潔/包皮手術
Circumcision before first sexual intercourse is associated with a reduction in the relative risk of PCa in this study population. These findings are consistent with research supporting the infectious/inflammation pathway in prostate carcinogenesis.
*Reference: Circumcision and the risk of prostate cancer.
Authors: Wright JL. Lin DW. Stanford JL, 2012

E) Healthy Sexual Activities – 健康性生活
(年齡較早的性行為，使前列腺癌的風險增加；多重性伴侶也會使前列腺癌的高度病變的風險增加。)
Findings of increased risk of PC associated with an earlier age at onset of sexual activity and an increased risk of high-grade disease with a larger number of lifetime partners are suggestive of multiple mechanisms contributing to the development of PC in this population. It remains unclear, however, how these underlying processes influence the development of PC and subsequent clinical outcomes. To our best knowledge, this is the first time that such associations have been reported in an African-origin Caribbean population. Further study will be necessary to elucidate the role of potential factors and agents in the pathogenesis of PC in this and similar populations.

*Reference: Urologic characteristics and sexual behaviors associated with prostate cancer in an african-Caribbean population in barbados, west indies.
Authors: Hennis AJ. Wu SY. Nemesure B. Leske MC, 2013.